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Title: Postoperative outcomes following cardiac surgery in non-anaemic iron-replete and iron-deficient patients - an exploratory study.
Austin Authors: Miles, Lachlan F ;Kunz, Stephen A ;Na, L H;Braat, S;Burbury, K;Story, David A 
Affiliation: Department of Haematology, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
Anaesthetic Peri-operative and Pain Medicine Unit, University of Melbourne, Melbourne, Australia
Department of Anaesthesia and Anaesthetic Peri-operative and Pain Medicine Unit, University of Melbourne, Melbourne, Australia
Melbourne School of Population and Global Health and Melbourne Clinical and Translational Science Platform (MCATS), University of Melbourne, Melbourne, Australia
Department of Cardiac Surgery, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Apr-2018 2017-12-02
Publication information: Anaesthesia 2018-04; 73(4): 450-458
Abstract: Iron deficiency anaemia is strongly associated with poor outcomes after cardiac surgery. However, pre-operative non-anaemic iron deficiency (a probable anaemia precursor) has not been comprehensively examined in patients undergoing cardiac surgery, despite biological plausibility and evidence from other patient populations of negative effect on outcome. This exploratory retrospective cohort study aimed to compare an iron-deficient group of patients undergoing cardiac surgery with an iron-replete group. Consecutive non-anaemic patients undergoing elective coronary artery bypass grafting or single valve replacement in our institution between January 2013 and December 2015 were considered for inclusion. Data from a total of 277 patients were analysed, and were categorised by iron status and blood haemoglobin concentration into iron-deficient (n = 109) and iron-replete (n = 168) groups. Compared with the iron-replete group, patients in the iron-deficient group were more likely to be female (43% vs. 12%, iron-replete, respectively); older, mean (SD) age 64.4 (9.7) vs. 63.2 (10.3) years; and to have a higher pre-operative EuroSCORE (median IQR [range]) 3 (2-5 [0-10]) vs. 3 (2-4 [0-9]), with a lower preoperative emoglobin of 141.6 (11.6) vs. 148.3 (11.7) g.l-1 . Univariate analysis suggested that iron-deficient patients had a longer hospital length of stay (7 (6-9 [2-40]) vs. 7 (5-8 [4-23]) days; p = 0.013) and fewer days alive and out of hospital at postoperative day 90 (83 (80-84 [0-87]) vs. 83 (81-85 [34-86]), p = 0.009). There was no evidence of an association between iron deficiency and either lower nadir haemoglobin or higher requirement for blood products during inpatient stay. After adjusting the model for pre-operative age, sex, renal function, EuroSCORE and haemoglobin, the mean increase in hospital length of stay in the iron-deficient group relative to the iron-replete group was 0.86 days (bootstrapped 95%CI -0.37 to 2.22, p = 0.098). This exploratory study suggests there is weak evidence of an association between non-anaemic iron deficiency and outcome after cardiac surgery after controlling for potentially confounding variables.
DOI: 10.1111/anae.14115
ORCID: 0000-0001-7424-9472
PubMed URL: 29197079
Type: Journal Article
Subjects: anaemia: iron deficiency
cardiac surgical procedures
outcome assessment (healthcare)
Appears in Collections:Journal articles

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